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心臟植入性電子儀器(CIED)之適應症"Indication for CIED"_20131019南區

2.
DBT Guideline
2012 ACCF/AHA/HRS Focused Update
Incorporated Into the 2008 Guidelines for
Device-Based Therapy of Cardiac Rhythm
Abnormalities
Developed in Collaboration With the American Association
for Thoracic Surgery, Heart Failure Society of America, and
Society of Thoracic Surgeons

11.
Sinus Node Dysfunction Sinus Bradycardia
Inappropriate marked sinus bradycardia
• Patient case:
• Elderly gentleman denied symptoms.
• Family reported that he napped frequently,
would fall asleep at the kitchen table during a
meal and often fell asleep when friends were
visiting.
• Patient was proud of his “athletic heart”,
particularly as he never exercised.

18.
AV Block
• Class IIb
– Neuromuscular disease, with or without
symptoms, as the progression is
unpredictable (b)
– AV block due to medications or drug
toxicity, expected to recur even after drug
withdrawn (b)
18

26.
2:1 AV Block
Mechanism based on preceding or
following rhythms
Lead II
Lead V1

27.
AV Block
Chronic Stable Complete Heart Block
•75-year-old man referred for “slow pulse”. Denies
syncope, presyncope. BUT lacks energy which he
attributed to his age!
In the presence of a normal sinus node, use the atrial
rate as an indicator of the degree of physiologic stress.

48.
ICD
• Class III
- Do not have a reasonable expectation of
survival with an acceptable functional status
for at least 1 year (c)
- Incessant VT or VF (c)
- Psychiatric illnesses that may be
aggravated by device implantation or that
may preclude systematic follow-up (c)
- NYHA IV with drug-refractory CHF, not
candidates for cardiac transplantation or
CRT-D (c)
48